Adult Volunteer Application (Live)

Thank you for your interest in the volunteer program at Harris Health System! Please complete the application fully to ensure a smooth onboarding process.

There are currently two types of placements, with two separate onboarding processes. Please review the requirements below, and indicate your interest in being considered for one or both types of placements.

Patient Contact Volunteer - In-person volunteering at a Harris Health facility

1) Some online training required
2) All volunteer service, medical clearance appointments, and badging appointments will take place in person
3) Full medical clearance:
Measles, Mumps and Rubella (MMR) - Two MMR doses or laboratory evidence of immunity (such as a titer) are required.
Varicella (chicken pox) - Two VARICELLA doses, laboratory evidence of immunity (such as a titer), or doctor's note certifying medical diagnosis of history of varicella disease are required. Shingles vaccines do not meet this requirement.
Pertussis (tdap) - One dose is required every ten (10) years.
Tuberculosis Titer - this blood test will be provided at no cost through Harris Health Occupational Health Services.
Influenza - One dose is required annually September - March. Occupational Health Services provides flu shots free of charge during the flu season.

Virtual Only Volunteer - all volunteer service conducted virtually

1) All training conducted online
2) Must have very strong computer skills: Microsoft Office, database, using apps on smart phone, etc.
3) Must have laptop/computer that meets tech specs, a smart phone, and reliable internet access to work in these roles.

If you do not meet the requirements for a program, please consider another option. Contact Volunteer Services with any questions you have regarding requirements.

Thank you for your interest in volunteering at Harris Health!

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New User Details

User ID

User ID (verify)

Password

Password (verify)

VOLUNTEER INFORMATION

Gender

Name prefix

* First Name

Middle Initial

* Last Name

* Date of Birth

* Home Address

* City

* State

* Zip Code

* Primary Phone

* E-mail Address

* Drivers Licence

* State Issued

* SSN

Shirt Size

Language

Additional languages

Ethnicity

Marital Status

EMERGENCY CONTACT INFORMATION

* Primary Contact Name (First,Last)

* Relationship

* Primary Phone

* E-mail

Home Address

City

State

Zip Code

VOLUNTEER INFORMATION

*Are you a returning volunteer?

Group Code

Volunteer Referral Source

Please select where you'd like to volunteer. For a map of Harris Health Locations click here.

Requested site - choose one (1)

Volunteer Type - SELECT ONE (1) - Selecting more than one option will delay your application process. Please read requirements at the top of this application before selecting your choice

Position Category

* Why would you like to volunteer with Harris Health?

Please list any previous volunteer experience:

Please indicate your availability below:

Length able to commit

* First Date Available:

* Last Date Available

Please indicate your best availabilty:

Sunday

8am-Noon

Noon-4pm

4pm-8pm

8pm-11pm

Monday

8am-Noon

Noon-4pm

4pm-8pm

8pm-11pm

Tuesday

8am-Noon

Noon-4pm

4pm-8pm

8pm-11pm

Wednesday

8am-Noon

Noon-4pm

4pm-8pm

8pm-11pm

Thursday

8am-Noon

Noon-4pm

4pm-8pm

8pm-11pm

Friday

8am-Noon

Noon-4pm

4pm-8pm

8pm-11pm

Saturday

8am-Noon

Noon-4pm

4pm-8pm

8pm-11pm

EDUCATION AND EMPLOYMENT INFORMATION

Highest Level of Education

School/Major:

Employment Status

Company Name

Current Job Title

Business Experience

PHOTO RELEASE:

As a Harris Health volunteer, I realize that my image may be taken at hospital celebrations and other media events. I give my permission to the Harris Health System Director of Volunteer & Guest Services and the Administrative Director of Corporate Communications to use my image in any appropriate and related materials that will promote or otherwise publicize the Volunteer & Guest Services department or Harris Health.*

BACKGROUND CHECK AUTHORIZATION:

* I authorize Harris Health System to conduct any and all inquiries necessary to determine my acceptability as a volunteer, including a thorough background check. I understand that this background check may include verification of personal and/or employment references, military information or police record inquiries.

* I am 18 years of age or older.

* By checking this box I agree to have Harris Health System conduct a background check.

Please Select

Choose if you have ever been convicted of or been on defferred adjudication for, or are you now either awaiting trial for or on deferred adjudication for, a felony or misdemeanor.

List and explain convictions if any:

CONFIDENTIALITY AGREEMENT:

I agree to use confidential or proprietary information only as needed to perform my volunteer duties. This means I will not access confidential or proprietary information without legitimate need/permission, nor in any way divulge, copy, release, sell, lend, revise, alter, or destroy any confidential or proprietary information belonging to Harris Health System. I understand that I will be automatically dismissed as a volunteer if I do not respect my responsibility for maintaining confidentiality.

If accepted as a Harris Health System Volunteer, I agree to the following:

* 1. Understand that it is a crime to solicit business for attorneys and/or insurance companies.

* 2. Authorize Harris Health System to provide me with a TB test as part of my volunteer service. Should I test positive, I understand that I must provide the Volunteer & Guest Services department with a letter from my physician stating that my TB is inactive before continuing my volunteer duties.

* 3. Am donating my services to the hospital district without expectation of compensation and am not to solicit employment while performing my volunteer duties.

* 4. Understand that the Volunteeer & Guest Services Department does not assign volunteers to areas of professional or medical confilicts of interest.

* 5. Will not sell or attempt to sell any goods or services, solicit monetary or in-kind contributions, or collect/distribute petition signatures on Harris Health System premises.

* 6. Understand that, I must never attempt to assess or diagnose any patients, nor shall I attempt to perform any medical procedures (i.e. draw blood, insert an IV and any other procedure that requires a medical license) on patients.

* 7. Understand that, I will be evaluated by the Volunteer & Guest Services Department, as well as the department in which I have been placed. I also will be given the opportunity to evaluate the deparment and the volunteer duties that I have been assigned.

* 8. Understand that the Volunteer & Guest Services Department reserves that right to terminate my volunteer status as a result of: Failure to comply with Harris Health System and departmental policies, rules and regulations; Unsatisfactory attitude, work or appearance/attire; Habitual tardiness and/or absences; and/or any behavior deemed unacceptable by any Harris Health System facility, department supervisor and/or the Volunteer & Guest Services Department.

* 9. I understand that, I am responsible for returning my badge and uniform to the volunteer and the Guest Services Department after completing my volunteer services.

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